New screen gauges hyperactivity

ADHD test aids tricky diagnosis

July 20, 2001|By Richard Wronski, Tribune staff reporter.

A few doctors in the Chicago area have begun using a new test they hope will bring more objectivity to one of the most controversial diagnoses of recent years: attention deficit hyperactivity disorder.

The behavioral disorder has been diagnosed in millions of U.S. children in recent decades, leading to a surge in the use of Ritalin and similar drugs. But assessment of the condition, which is largely subjective, has generated a backlash from those who believe the problem is overdiagnosed and often misidentified.

Now researchers at Harvard University Medical School believe they have come up with a high-technology screening process that will give doctors a better basis for measuring the behavior of an individual child.

The test, called OPTAx, short for optical tracking and attention test, asks children to respond to moving targets on a computer screen. It also monitors head movement for signs of a key indicator of the disorder, hyperactivity.

"The OPTAx test is cutting edge because other tests don't measure the hyperactivity component," said Dr. Michael Feld, a psychiatrist who directs the program at Alexian Brothers Behavioral Health Hospital in Hoffman Estates. Alexian Brothers began using the test in May; it is also being used at facilities in Barrington, Elgin, Streamwood, River Forest and Orland Park.

But other doctors warn that OPTAx, like other tests, cannot substitute for professional judgment.

"OPTAx is thorough but it's not going to stop the need for a clinical evaluation," said Dr. Karen Pierce, a child psychiatrist at Children's Memorial Hospital in Chicago. "The problem is, people don't take the time to properly diagnose ADHD ... It's not something you can do in a 15-minute exam or any one test."

The National Institute of Mental Health says about 3 percent to 5 percent of all school-age youngsters have ADHD, and that about one child in every classroom in the U.S. needs help for this disorder.

Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD), a national advocacy and support group, estimates the total number of children with ADHD at 3.5 million.

"The greatest criticism of ADHD is that [doctors] just dreamed it up," said Dr. Anthony D'Agostino, a child psychiatrist and medical director of Alexian Brothers. "Like with every other medical test, we like to have objective evidence."

OPTAx is given to children ages 6 to 12 to measure the key symptoms of ADHD: inattention, impulsiveness and hyperactivity. Developed by Harvard psychiatrist Martin Teicher, OPTAx was presented at the May meeting of the American Psychiatric Association.

During the 15-minute OPTAx test, the child sits before a computer screen and is challenged to respond to the appearance of moving stars. The speed and accuracy of the child's responses provide data on attentiveness and impulsiveness.

An infrared camera tracks a marker on the back of the child's head, recording every move to judge hyperactivity.

The physician transmits the data via the Internet to a database at the Developmental Biopsychiatry Research Program of McLean Hospital at Harvard. In return the physician receives a report detailing 12 measures of inattention, impulsiveness and hyperactivity, comparing the subject's scores with those of 1,800 other children.

OPTAx's proponents say the test is an improvement over predecessors because it requires the child to track moving targets, as opposed to stationary ones, and uses stars rather than letters, which kids can misread.

OPTAx "is a great tool for parents who want objective data, and to see if they want kids on medication like Adderall or Ritalin," Feld said. "I have seen test results that show medication hurts rather than helps."

But other medical professionals say OPTAx could introduce a new set of problems.

Dr. Russell Barkley, professor of psychiatry and neurology at the University of Massachusetts, said he did not see any value in OPTAx. "The difficulties with such tests is that too many ADHD children can pass them and thus a normal score on the test does not mean ADHD is not present," he said.

Dana Pederson of Streamwood said having her son, Alex, 7, take the test at Alexian Brothers allayed her family's concern over Alex's diagnosis.

"ADHD is so vague, so ambiguous. We never felt we had a good measurement of what was going on inside Alex," Pederson said. "This test ... measured every fidget, every move."

"The whole diagnosis process is so difficult--it's very hard to separate emotions from actual facts," she added. "With OPTAx there is no emotion involved."